FORM 1023-EZ for FBC OF SH YOUTH MINISTRY

Field Data
EIN 81-3305310
Case Number EO-2016334-000133
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name FBC OF SH YOUTH MINISTRY
Organization’s Mailing Address 57 HALSEY AVE
City SOUTHAMPTON
State NY
ZIP 11968-3412
Accounting period End 6
Primary contact name CYNTHIA MACK
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $275.00
Officer/Director/Trustee One

TAMMY C
PRESIDENT
1017 HUTTON WAY
YAPHANK NY 11980

Officer/Director/Trustee Two

LISA MYRICK
VICE PRESIDENT
44 HAMPTON COURT
BRIDGEHAMPTON NY 11932

Officer/Director/Trustee Three

CYNTHIA MACK
TREASURER
PO BOX 1630
EAST HAMPTON NY 11937

Officer/Director/Trustee Four

JACKIE POOLE
SECRETARY
PO BOX 1204
BRIDGEHAMPTON NY 11932

Organization’s website
Organization’s email FBCSHYOUTHMINISTRY@YAHOO.COM
Organization Incorporated No
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 6/20/2016
Organization Incorporation State NY
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O51 - Youth Community Service Clubs
Organization’s purpose Charitable: Yes
Religious: No
Educational: No
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States No
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public No
One Third Support Gifts Yes
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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